Facilitation in Inducing Folie a Deux Through Healthy Precipitator

“Mr. G” was a 23-year-old man with no history of psychiatric disorder. He was hospitalized with a paranoid delusion that his brother-in-law was a Mafia leader who had plans to murder him. Mr. G also heard voices telling him to kill himself or he would be subjected to torture. Consequently, he tried to strangle himself in the hospital.

Additional history revealed that Mr. G’s sister developed similar symptoms prior to his hospitalization and that she had been in close contact with him during that time. Their mother was aware of her daughter’s delusional ideas. While the mother did not believe in the delusions, she provided her daughter with unconditional support and even checked her house for surveillance equipment without asking questions. The mother felt an obligation to maintain family cohesion, even if her actions contradicted her own comprehension of reality. Therefore, she avoided any confrontation with her daughter out of fear the daughter might commit suicide, which is what an uncle did several years previously.

Subsequent to his sister’s delusions, Mr. G’s first psychotic symptoms appeared when he realized that his mother was fully supportive of his sister’s beliefs. Notably, his psychosis exacerbated only after his mother’s visits on the psychiatric ward, and his attempt to strangle himself occurred after a visit from her. He received intensive treatment with doses of diazepam (30 mg/day) as well as individual and family psychotherapy that focused on reality testing of both the patient and the family.

It became apparent that the mother played a major role in the family and had indirectly supported Mr. G’s psychosis. Following intervention to clarify the mother’s influence on Mr. G, she changed her attitude and denied explicitly the existence of his delusions. Consequently, Mr. G began to improve rapidly. After six sessions of family psychotherapy, he was free of psychosis and could be discharged.